Ngozi Ezike, MD (Host): Hello everyone. I'm Dr. Ngozi Ezike, and thank you so much for tuning into the second episode of More Than Medicine. This podcast is about the fight for health equity and justice. How we need to work to not just heal wounds, but truly address the root causes of hurt and distress in our communities and in our nation.

This episode, we are talking about the state of health for Blacks in Chicago. A report that the Chicago Department of Public Health released in 2021. It describes the health status of Chicago's Black population and the root cause inequities disproportionately affecting the lives of Black Chicagoans.

Today I am so pleased to be joined by Dr. Wilnise Jasmin, the Medical Director of Behavioral Health at the Chicago Department of Public Health. Her leadership team is responsible for the city's initiatives in the areas of violence prevention, substance abuse, and recovery, and mental health. Thank you for joining us, Dr. Jasmin.

Wilnise Jasmin, MD: Thank you for having me today.

Ngozi Ezike, MD (Host): Oh my gosh, it's such a pleasure. It's such a pleasure. I'm so familiar with your work, but this is my first time really getting to engage with you. So thank you for making this time. I just want to know a little bit about you. Can you just tell us a little bit about yourself and how you got started into your career?

Wilnise Jasmin, MD: Thank you for asking. For me, my background's in family medicine and preventive medicine. Deciding on these two areas, it came at different parts in my life. So when I was in college, I was interested in global health, and in sharing health related information with the general public.

And it was also around that time that 911 occurred. And I really got to see how, I'm from New York City originally, so, at that time, New York City's Department of Health and Mental Hygiene, I was in awe with the work that they were doing following 911, and I saw that the physicians there, they specialized in preventive medicine. And so for me, I thought that was a good fit for me.

Host: Oh no. That's awesome. So that's really interesting. Of course, you're a New Yorker, but you're now, leading up the Behavioral Health team at the Chicago Department of Public Health. How'd you get involved with CDPH?

Wilnise Jasmin, MD: So I also, because I specialize in family medicine, I did my residency training at Cook County Hospital, so that was my first introduction to Chicago. And so when I was ready to begin working for a health department, I saw there was an opening in Chicago's Health Department Department so I applied and got in.

Host: That's awesome. Well, we are so happy to have you here in the Chi and because you're here, you were part of this incredible report, the state of Health for Blacks in Chicago. Can you help our listeners understand some of the biggest findings from that report?

Wilnise Jasmin, MD: Yeah, I'd be happy to share that information with you. So within the health department, the report was really spearheaded by five black women. You'll see there are names out to share it at the end, who formed the Health Equity Index Committee, here at the health department. They really wanted to share for the first time information that was uniquely focused on the state of Black health and just comparing Blacks as a whole with other groups as a whole, combining other groups, oftentimes you see a gap between Black and white or Black and Asian. And this report is framed in a way that other demographic racial groups are grouped together and then comparing that to Blacks.

And so we see that one of the main findings from this report is that the Black life expectancy has decreased and when you compare it to non-blacks, the life expectancy is a little bit over nine years less. So that's something when you try to look at what the drivers are, we see the drivers align similarly to when we normally talk about the Black white life expectancy gap. But specifically, before we would say chronic disease. Here we see diabetes as that main contributing chronic disease of that gap, opioid deaths, homicide, infant mortality all align between both measures. And then when it comes to infectious diseases, HIV is that main contributor of the gap we see.

Host: So from that list, you see that it's from birth to things that would happen to people in their earlier years, all the way to some of these chronic diseases that we see sometimes in maybe more advanced age. So at every stage, there are things that we're worried about.

So as you've identified, these issues, what are the things that we should be doing to eliminate these inequities?

Wilnise Jasmin, MD: Yeah, so some other things that we look at, look at the distribution of neighborhoods. So, 'it's pretty well known that Chicago is a really segregated city, and you can see that in the maps that's provided in the report. Shows which community areas have Black population where it's more than 80% of the total population in the community area. You see that focus a lot on the west and south sides of Chicago. Also superimposed on that, you look at hardship index. So, it's a measure people who live in the community area, if they're able to get access to the things they need every day, to support their health in general. So things like their income level, highest education achieved, access to safe and healthy foods, job security; all that is factored into the hardship index.

Host: Yeah. No, it's, it's amazing work. And you know, as we've identified some of the challenges and the causes, let's talk about what are some of the solutions? Like where dowe go with this wealth of information that you have compiled in this report, where are we going from here with yhis?

Wilnise Jasmin, MD: So with this information, I think with the Health Equity Index Committee, the overall goal is to make sure that information is readily available, especially for community driven projects. So oftentimes you need funding to get projects off the ground, and this report can be used. You need to include data to say, Hey, a problem exists. And this report can be used to potential funders, to help launch initiatives that can help reverse these gaps that we're seeing.

Host: That's great. It's such a great compendium of information for any community organization or community driven project to make sure that they are really addressing the real needs. So I know that you have this report and we know that, COVID happened shortly within this time, and we know that that had a significant impact. How would you say that COVID affected the health equity in Chicago?

Wilnise Jasmin, MD: We saw during that time, the life expectancy across all racial demographic groups decreased. That was heavily influenced by COVID. We saw unprecedented number of people who died from COVID. This was before any vaccine or treatment options were widely available. In general, the whole world was learning how to address and treat this condition. So I think that was a major contributor.

Host: Absolutely. Now, in your really critical role as the Director of Behavioral Health at CDPH, we have absolutely seen the rise in behavioral health issues. So how has and there's a definite relation between COVID and behavioral health. So what are we doing specifically in the field of behavioral health to address and tackle some of these issues?

Wilnise Jasmin, MD: So, the Bureau of Behavioral Health has three main programmatic areas. So one is violence prevention. Second is mental health and the other is like addiction and opioid related substance use initiatives throughout the city. So one of the top five drivers of this gap you see, is opioid related deaths and In 2019, the Health Department received funding from the CDC, to really help launch a lot of the initiatives we have in place now to help address this issue.

And so I could tell you about some of these initiatives. So one, when we look at the stigma attached with drug use, that may often lead to those who are in the throes of addiction being involved with the criminal justice system. We work with the police department and an organization called Thresholds to rather than arrest someone who's found with a personal use amount of a drug, really divert them from being arrested and actually provide harm reduction education and linkage to treatment for those who are ready to enter treatment. That's one project.

Another is really making sure in general, people are aware of what are the signs and symptoms of an overdose and that really empower everyday people to intervene when they see, if they see someone who's experiencing an overdose and making sure they have access to the overdose reversal medication naloxone. So we've worked with the Chicago Public Library System to make sure that naloxone is available in each of the locations. We are really excited about this partnership as well.

Host: That's amazing. We know that it's all about partnership. We definitely have services that may be siloed, but a person's life is not siloed and they need all of these services that all these different institutions bring to bear. So, here at Sinai, I'm trying to think, the City Health Department should obviously be working with hospitals and health systems and Sinai is obviously engaged and committed to this work. What is the role that you look for providers at an institution like Sinai? What's the role for us to play?

Wilnise Jasmin, MD: So I think everyone has, when you're looking at direct service providers and treatment providers, making sure your clients and your patients that are on your panel, to provide close follow up with them. If you find that you're making appointments and they're not coming, really make the effort to reach out to see why they're not coming, to make sure they have their normal screenings.

And see if there are any other additional services or needs. So if you think about, let's say a person who recently delivered a baby. During that first few weeks or months, they may need that extra support. New mom may experience depressive symptoms and so as a health system, could really make sure that moms who show any signs of depression, that they get connected to the mental health resources they need to support them. That's one example.

Host: I mean, there are so many projects that should be springing up given this great report and being able to like direct us in the right direction. So I'm confident that more and more initiatives will help to narrow that gap. I know you described it as nine years, but for some communities it, it goes almost 14, 15 years if you compare certain communities, even in the catchment area that Sinai serves on the, on the west side and the southwest side.

So as we're all working towards this, what are the huge barriers or can you identify specific barriers that are really holding us back from achieving the equity and the justice that we actually all hope to see?

Wilnise Jasmin, MD: So, when we are thinking about how what's the answer in terms of how do we address this gap? I think working with the Chicago Health Equity zones. The city is divided into six regions and in each of those regions, the Health Department has partnered with community-based organizations that really know the area, and then are able to have a connection with the people who live there.

And with the Health Equity Zone initiative, the community-based organization is able to provide surveys, really get input from the people who live in those regions, for the community to decide what are the health priorities that they would focus on. So some of these priorities may have been related to mental health, some related to chronic disease, some opioid related issues, and I think with this initiative, there also was a program called the Data Academy.

So led by one of our senior epidemiologists, Margarita Reina, worked very closely with the Health Equity Zone leads, to make sure that community members were able to access at least, in the Health Department, the data that's widely available to the public. So they know how to set benchmarks for the community and monitor the progress for any intervention that they decide to implement.

Host: That's fantastic. I'm really just still so grateful for, for all this work that you and the team, you know, this committee put together and it's going to help us for generations to come because of the the initiatives that will be able to focus on this data and then make the appropriate initiatives to improve these inequities that you've so well laid out. I know that it's an important body of work. I'm very proud of it. You must be, are you hopeful, for what we're going to see in the future? What do you, what do you think is going to be next? What's going to be some of the outcomes of this important work?

Wilnise Jasmin, MD: Yeah, I'm definitely hopeful because I don't think I'd be in this field if I didn't have hope of making an impact to change something for the better. So I do really want to some of the hope I have for this long-term program ultimately to see this gap eliminated that we see between blacks and non blacks in the city.

But also for each individual to feel empowered, to know what resources are available to them if they're in need for anything. And also be empowered to share their personal resources. It's when we work together, that we're able to really uplift and improve the conditions of the community. And part of that is being, I think, civically engaged cause that can also help your community receive more resources that it would need to help everyone who lives there.

Host: Of course. It takes a village, like everyone has a role. This is not just a job for CDPH or just for some community based organizations, but everyone has to get engaged and get our legislators engaged for this critical work, cause we know these inequities didn't start over the last couple of years. It's been centuries and so it's going to take a lot of work to dismantle some of these clear obstacles and barriers that have created it. But by laying out where we are and identifying some strategies, you've really given us a roadmap and I'm excited for the future because of it. I just want to thank you again, Dr. Jasmin, for joining me and for your leadership and for your efforts in addressing these inequities. It's a serious matter of health injustice and we are working to overcome it. I really look forward to hearing more about the work and the research that you continue to do at CDPH. And I just thank you so much for your time today.

Wilnise Jasmin, MD: Yeah, you're welcome. And I'd be remiss if I also didn't name specifically the writers behind the report. Blair Akins, Dana Harper, Rochelle Paul Brutus, Donna Stretchings and Ya Simpson.

Host: Well, thank you for highlighting the whole group who made up that Health Equity Index Committee. And, we are really grateful for all of their contributions to this important work.

Wilnise Jasmin, MD: Yeah, same here.

Scott outro: Thank you for listening to More Than Medicine with Dr. Ngozi Ezike. If you haven't already, make sure to subscribe to Sinai Chicago's YouTube channel, as well as follow at Sinai Chicago on Twitter, Facebook, and Instagram for information on upcoming podcasts. Until next time.